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Original Research |

Efficacy of an Adjustable Oral Appliance and Comparison With Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea SyndromeAdjustable Oral Appliance Efficacy

Aaron B. Holley, MD; Christopher J. Lettieri, MD, FCCP; Anita A. Shah, DO
Author and Funding Information

From the Department of Pulmonary/Sleep and Critical Care Medicine (Drs Holley and Lettieri), Walter Reed National Military Medical Center, Bethesda, MD; and Pulmonary and Critical Care Department (Dr Shah), Madigan Army Medical Center, Tacoma, WA.

Correspondence to: Aaron B. Holley, MD, Walter Reed National Military Medical Center, Department of Pulmonary/Sleep and Critical Care Medicine, 8901 Wisconsin Ave, Bethesda, MD 20889; e-mail: aholley9@gmail.com

Data are presented as mean ± SD or %. AHI = apnea-hypopnea index; ESS = Epworth Sleepiness Score; HTN = physician diagnosis; OSA = obstructive sleep apnea; PSG = polysomnogram; Spo2 = oxygen saturation by pulse oximetry; TST = total sleep time (in min).

a

AHI 50% less on side when compared with supine, and AHI < 5 on side.

Data are presented as mean ± SD or %. aOA = adjustable oral appliance; REM = rapid eye movement sleep. See Table 1 legend for expansion of other abbreviations.

a

Data reflect AHI at final turn.

O2 = oxygen. See Table 1 and 2 legends for expansion of other abbreviations.

Data are presented as mean ± SD or %. CPAP = continuous positive airway pressure. See Table 1 legend for expansion of abbreviations.

Data are presented as mean ± SD or %. See Table 1 and 2 legends for expansion of abbreviations.

a

AHI 50% less on side when compared with supine, and AHI < 5 on side.

See Table 1 legend for expansion of abbreviations.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1511-1516. doi:10.1378/chest.10-2851
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Background:  We sought to establish the efficacy of an adjustable oral appliance (aOA) in the largest patient population studied to date, to our knowledge, and to provide a comparison with continuous positive airway pressure (CPAP).

Methods:  We conducted a retrospective analysis of patients using an aOA. Results of overnight polysomnography with aOA titration were evaluated and compared with CPAP. Predictors of a successful aOA titration were determined using a multivariate logistic regression model.

Results:  A total of 497 patients were given an aOA during the specified time period. The aOA reduced the mean apnea-hypopnea index (AHI) to 8.4 ± 11.4, and 70.3%, 47.6%, and 41.4% of patients with mild, moderate, and severe disease achieved an AHI < 5, respectively. Patients using an aOA decreased their mean Epworth Sleepiness Score by 2.71 (95% CI, 2.3-3.2; P < .001) at follow-up. CPAP improved the AHI by −3.43 (95% CI, 1.88-4.99; P < .001) when compared with an aOA, but when adjusted for severity of disease, this difference only reached significance for patients with severe disease (−5.88 [95% CI, −8.95 to −2.82; P < .001]). However, 70.1% of all patients achieved an AHI < 5 using CPAP compared with 51.6% for the aOA (P < .001). On multivariate analysis, baseline AHI was a significant predictor of achieving an AHI < 5 on aOA titration, and age showed a trend toward significance.

Conclusions:  In comparison with past reports, more patients in our study achieved an AHI < 5 using an aOA. The aOA is comparable to CPAP for patients with mild disease, whereas CPAP is superior for patients with moderate to severe disease. A lower AHI was the only predictor of a successful aOA titration.


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